MedicalMimehttp://medicalmime.com
EHR for Substance Use and Addiction TreatmentTue, 26 Feb 2019 22:14:56 +0000en-US
hourly
1 https://wordpress.org/?v=5.2.15 ways an EHR can help your practicehttp://medicalmime.com/5-ways-an-ehr-can-help-your-practice/
http://medicalmime.com/5-ways-an-ehr-can-help-your-practice/#respondTue, 26 Feb 2019 22:13:06 +0000http://medicalmime.com/?p=2834While researching the often cited physician burnout from EHR burdens, I came across the above nice infographic from Practice Velocity. It lists the 5 ways an EHR can benefit your practice.

While written originally for urgent care ambulatory settings, much of this holds true for addiction treatment settings as well:

Save Time: Whether it’s the various information captured during Intake or other important points during treatment, a well organized EHR workflow can streamline all the documentation and move from messy paperwork to well-structured, secure online storage.

Improve Patient Care: The use of templates helps with repetitive processes; at the same time, customization is important to avoid using the same boilerplate approach to every patient. Integration with various lab or billing systems (see our page on Product Integrations) as well as electronic prescribing of medications are standard features of modern EHR systems.

Easily Access Data: The patient chart with the entire context of past encounters and treatments, medication allergies, demographic information, insurance information etc. is a central component of modern EHR systems. With Software as a Service offerings this information is securely hosted in the cloud and can be accessed remotely from a variety of devices.

Painless Implementation: Many early (especially large scale) EHR projects resulted in failure because the system was too complex, not intuitive to use, and/or users weren’t properly trained. At MedicalMime we pride ourselves in delivering a very intuitive system that is easy to use and easy to learn. In facilities with new staff or frequent turnover this becomes especially important. From earlier post on What Customers Are Saying, our VP Sales used to say: “You can start to use our product after 1 hour. You can be more productive with it after 1 day. You can be fully proficient with it after 1 week.” A good amount of training is included in our implementation fee.

Increase profits: Capturing all encounters and billable services is a key requirement to streamline billing. Our solution specialists have come up with simple, yet effective ways to do so using our custom forms and custom reports templates to help you quickly document all billable services. This will help your practice regardless of which billing system you might be using.

For more ways on how our EHR can benefit your practice, check out our 25 Questions to Ask when considering an EHR for your practice!

]]>http://medicalmime.com/5-ways-an-ehr-can-help-your-practice/feed/0What the U.S. Opioid Epidemic and Global Financial Crisis have in commonhttp://medicalmime.com/what-the-u-s-opioid-epidemic-and-global-financial-crisis-have-in-common/
http://medicalmime.com/what-the-u-s-opioid-epidemic-and-global-financial-crisis-have-in-common/#respondMon, 04 Feb 2019 15:52:41 +0000http://medicalmime.com/?p=2823On Feb-1, 2019 Project Syndicate published an article titled “How to Help Deflate America’s Opioid Bubble” (link). In it the authors look at what policymakers can do to deal with the opioid epidemic in the United States. And they make what seems at first to be a non-intuitive suggestion:

To figure out how to resolve it, policymakers should look for lessons in what may seem to be an unrelated episode: the 2008 global financial crisis.

They identify as one of the main causes of the opioid crisis the use of “aggressive commercial and marketing tactics by pharmaceutical companies”. In their opinion, the current FDA’s programs don’t “do enough to control the incentives provided by drug manufacturers to prescribers and patients”. Here is the main comparison narrative:

Just as the promotion of opioid painkillers like OxyContin (sold by Purdue Pharma) has been a key driver of the opioid crisis, unethical “hook strategies,” facilitated by lax mortgage-lending practices, were a major cause of the 2008 financial crisis. In both cases, many individuals were lured into making risky decisions – whether taking out a mortgage they couldn’t afford or treating their pain with a highly addictive drug – by attractive “introductory offers.”

The article goes on to discuss the role the Consumer Financial Protection Bureau (CFPB) in overseeing financial products and services offered to consumers. One of the key aspects was to limit the use of introductory pricing in mortgage loans – one of the key ingredients in the housing bubble and subsequent financial crisis. In comparison to the opioid crisis,

… pharmaceutical companies offered free samples and savings coupons to doctors, who then prescribed to patients who often were not made fully aware of the addictive nature of the substances they were consuming. Many of these patients then became addicted to opiates, with a large number of them eventually dying from drug overdose.

Just like in the case of the financial sector, the large companies and lobby groups resist such protective measures. For instance,

…the Pharmaceutical Research and Manufacturers of America, the largest drug-lobby group in the US, vigorously defends the practice of providing free samples of prescription drugs to physicians.

In a somewhat related news clip from Health Law 360 (pay wall) this morning (Feb-4), here is an attorney general’s view on this dynamic:

Purdue Pharma LP’s controlling Sackler family paid itself $4.2 billion in opioid money over 10 years as the company aggressively pushed sales and then tried to use its knowledge of addiction to expand into the treatment market, according to newly public allegations in a suit brought by the Massachusetts attorney general.

When incentives grow this large and lead to distorted outcomes (good for a few, bad for many), the market economy may need a healthy dose of regulation. When millions are addicted and tens of thousands of Americans die each year, it’s hard to see this as a case of the “free market knows best” and the “consumer is always right”. Just like financial asset bubbles repeat, unfortunately the lessons learned from the global financial crisis in 2008 have not been properly applied in the subsequent decade.

One positive trend can be seen in the chart below from Statista showing the declining total number of opioid drug prescriptions in the United States from 2014 through 2017:

Number of annual opioid prescriptions in the U.S. from 2014 to 2017

]]>http://medicalmime.com/what-the-u-s-opioid-epidemic-and-global-financial-crisis-have-in-common/feed/0Joint Commission Auditshttp://medicalmime.com/joint-commission-audits/
Wed, 16 Jan 2019 17:31:12 +0000http://medicalmime.com/?p=2792Together with partner BLH Psych Services, LLC we conducted a breakfast event at MedicalMime headquarters to learn about what it takes to pass a Joint Commission (JC) audit. The 7-step process overview showed how BLH Psych Services approaches accreditation and how MedicalMime’s EHR rehab system can help to obtain and maintain JCAHO accreditation.

The 7 steps can be summarized as follows:

Keep up to date on The Joint Commission standard changes.

Policies and Procedures are current to the organizations practice.

Review clinical records and forms – update deficiencies.

Structure the organization based upon identified roles & responsibilities.

From experience, customization (of the accreditation process and the Electronic Health Record system) plays a key role. According to estimates from Bridget Heady, BLH Psych Services, around 60% of JC surveys are based upon your services provided and documented within your EHR. So ensuring that an EHR can be customized and easily changed is vital to achieve and maintain compliance.

Click below if you’re interested in downloading the slides from the presentation.

The current disparity in accessibility to pain relief in various countries is significant; the U.S. produces or imports 30 times as much pain relief medication as it needs while low-income countries such as Nigeria receive less than 0.2% of what they need, and 90% of all the morphine in the world is used by the world’s richest 10%.[53]

Drug overdoses have become the leading cause of death of Americans under 50, with two-thirds of those deaths from opioids.[6]

Several of the charts and newspaper articles have been covered here before, including the rise in opioid overdose deaths as well as the reduction in US life expectancy since 2015. The article cites more than 200 reference links to other studies and articles. Overall well worth a read.

]]>http://medicalmime.com/wikipedia-on-opioid-epidemic/feed/0HHS Awards $1 Billion to Combat the Opioid Crisishttp://medicalmime.com/hhs-awards-1-billion-to-combat-the-opioid-crisis/
http://medicalmime.com/hhs-awards-1-billion-to-combat-the-opioid-crisis/#respondMon, 15 Oct 2018 18:31:01 +0000http://medicalmime.com/?p=2703In September 2018, the U.S. Department of Health and Human Services (HHS) awarded over $1 billion in opioid-specific grants to help combat the drug overdose crisis. We have written about this crisis which caused 72,000 deaths in 2017 and about a year ago here.

It appears as if at the state level, various things have been learned about what works well and what doesn’t. Says Secretary Alex Azar in the HHS article:

“The more than $1 billion in additional funding that we provided this week will build on progress we have seen in tackling this epidemic through empowering communities and families on the frontlines.”

The bulk of these grants ($930 million) is awarded to the 50 states via the Substance Abuse and Mental Health Services Administration (SAMHSA). A breakdown by state can be seen at the SAMHSA.gov website here. Here is a map indicating the $ amounts awarded by state:

A billion dollars sounds like a lot of money, but when distributed by the total population it is only about $3 per person in the United States. The awards by state are quite uneven: From as high as $17.02 for New Hampshire to as low as $1.39 for Kansas. (Not to mention $30.03 for Washington, DC – which was left out of the chart as it skews the color legend!)

Another roughly $400 million has been awarded through the Health Resources and Services Administration (HRSA). The majority of that ($352 million) is to increase access to substance use disorder and mental health services to 1,232 community health centers across the nation.

Another ~$190 million has been awarded through the Centers for Disease Control and Prevention (CDC), mostly for preventing opioid-related overdoses, deaths, and other outcomes.

Any user of the system would see a link to a brief survey on their login page. This survey asked two simple questions as follows:

Answers were selections on a 5-point Likert scale, ranging from Strongly Agree (5) to Strongly Disagree (1). This type of usability survey is called UMUX-Lite; the methodology behind this type of survey is described here. The basic idea is that with a minimum of effort (just 2 questions) one can glean a large percentage of the insight gained from much more involved surveys (such as the 10 question Standard Usability Survey SUS).

The results of the survey are tabulated below:

A column chart visualizes these results as follows:

Interpretation of the results:

89.1% or about 8 out of 9 users either agree or strongly agree that MedicalMime’s capabilities meet their requirements.

87.5% or about 7 out of 8 users either agree or strongly agree that MedicalMime is easy to use.

4.7% or about 1 in 21 users either disagree or strongly disagree on the above dimensions. About the same percentage is neutral.

Additionally, a free-form text field was provided to allow for comments and feedback. About half of the responses included comments. These comments were very useful in several regards:

Highlighting which particular areas customers like

Pointing out areas of improvement, often through minor changes or enhancements (for example in MAR or group notes)

Positive feedback about product and customer service

Comparison to other products customers have used prior to MedicalMime

A big THANK YOU to all participants who took the time to respond and especially the many useful comments.

In general, we are happy with the results. They confirm our sense from informal interactions that most customers really like using our product.

To be sure: We are not happy about the ~5% disagree responses. We have reached out to those users to better understand their specific issues and to see how we can help. In fact, the whole point of this survey was to learn about what we can do better. And listening to responses one doesn’t like to hear often provides the best feedback to improve the product!

As incentive to fill out the form we sponsored a $100 Amazon gift card. The prize was randomly selected on Tuesday, 9/4 through a little MedicalMime team ceremony (and Excel’s RANDBETWEEN() function). The lucky winner of the $100 gift card is:

Natalie Ruggiero (Best Life Counseling)

Congratulations and thanks again for your participation.

]]>http://medicalmime.com/medicalmime-usability-survey/feed/172,000 overdose deaths in 2017http://medicalmime.com/72000-overdose-deaths-in-2017/
http://medicalmime.com/72000-overdose-deaths-in-2017/#commentsTue, 28 Aug 2018 16:30:11 +0000http://medicalmime.com/?p=2629In mid-August the Center for Disease Control has released preliminary estimates for the number of Americans killed last year by drug overdoses: 72,287. That is almost 200 people dying every day in 2017. This death toll is staggering – the equivalent of a passenger jet crashing every day for an entire year.

Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.

Another article in the Washington Post (WaPo; Aug-15, 2018) points out that synthetic drugs including Fentanyl are responsible for the recent steep rise in lethal overdoses.

The regions affected most in terms of density of overdose death by 100,000 residents haven’t changed much:

The Appalachian region is still the hardest hit, with West Virginia showing the highest mortality rate with 58.7 overdose deaths per 100,000 residents.

That said, the trends are not the same across all regions. To better visualize this, check out a web-page published by the National Center for Health Statistics titled Provisional Drug Overdose Death Counts: It shows dashboards including with estimates, actual reported and predicted numbers and allows to download the underlying datasets. It is also updated every month as new data is received to provide the most recent 12-months ending period reports. From this web-page, here is the most recent growth trend by state:

The NYT article interprets these findings as follows:

In much of the West, overdose deaths have been flatter as the epidemic has raged in parts of the East and Midwest. That geographical pattern may be a result of the drug supply. Heroin sold west of the Mississippi tends to be processed into a form known as black tar that is difficult to mix with synthetic drugs. The heroin sold toward the east is a more processed white powder that is more easily combined with fentanyls.

Overdose deaths rose sharply in several mid-Atlantic and Midwestern states. In Ohio, Indiana and West Virginia, where the opioid death rate has been high for years, overdose deaths increased by more than 17 percent in each state. In New Jersey, they rose 27 percent.

Amidst all these depressing numbers, the author (Margot Sanger-Katz) finds some reasons for optimism, such as this:

In Dayton, Ohio, a hot spot for the epidemic, public health officials are seeing signs of progress. After instituting a new emergency response strategy — and drawing from new federal and state grant funds — the county health department has documented reductions in overdose deaths, emergency room visits and ambulance calls of more than 60 percent between January 2017 and June of this year.

The county has reduced medical opioid prescribing; increased addiction treatment resources; expanded community access to an anti-overdose drug called naloxone; and provided addiction treatment to prisoners in its county jail, among other measures.

Wherever addiction treatment is administered, we here at MedicalMime are happy to support those forms of treatment through our EHR (rehab) specifically designed for addiction treatment.

]]>http://medicalmime.com/72000-overdose-deaths-in-2017/feed/1How much does mental illness reduce life expectancy?http://medicalmime.com/how-much-does-mental-illness-reduce-life-expectancy/
http://medicalmime.com/how-much-does-mental-illness-reduce-life-expectancy/#respondThu, 31 May 2018 22:46:50 +0000http://medicalmime.com/?p=2498The New York Times published an article yesterday (30-May-2018) titled “The Largest Health Disparity We Don’t Talk About” by Dhruv Khullar. The finding of several studies is that:

Americans with serious mental illnesses die 15 to 30 years younger than those without.

One of the studies referenced in the article is a 2006 paper on causes of death, mortality rates and years of potential life lost by Craig Colton and Ronald Manderscheid. This study looks at data across 8 different US states. While there are some interesting differences between states, some general patterns emerged. Consider the following histogram charts for the state of Texas from an analysis covering the years 1997 – 1999:

Leading causes of death in general populations (All) and public mental health clients (MH) nationwide and statewide in Texas, 1997 – 1999

One visible difference is a significantly higher percentage of suicides among mentally ill compared to healthy population (the white bars are much higher in the MH compared to the All cases). Similarly, there are relatively speaking more accidents, including motor vehicles, indicating perhaps impaired judgment or more risky behavior.

While those are hardly surprising, another clear result is that the leading causes of death – heart disease and cancer – are structurally similar across mentally ill and healthy people. As the NYT article puts it:

We may assume that people with mental health problems die of “unnatural causes” like suicide, overdoses and accidents, but they’re much more likely to die of the same things as everyone else: cancer, heart disease, stroke, diabetes and respiratory problems.

I was a bit surprised by this finding, because prior to seeing these statistics and thinking about it, I certainly shared the above assumption that mentally ill people die of different causes.

The finding that mentally ill people have drastically shorter life expectancy – 15 to 30 years less compared to mentally healthy people – is attributed to several factors, including struggles with homelessness, poverty and social isolation. They have higher rates of obesity, physical inactivity and tobacco use. Many don’t receive treatment, and for those who do, there is often a long delay. When these patients do make it into our clinics and hospitals, their troubled mind can distract doctors from an ailing heart or a budding cancer. The shortcomings of medical care for mentally ill patients are attributed to two related biases:

The first is therapeutic pessimism: “Clinicians, including mental health professionals, often hold gloomy views about whether patients with serious mental illness can get better. This can lead to a resigned passivity, meaning that certain tests and treatments aren’t offered or pursued.”

The second is a concept called diagnostic overshadowing, “by which patient’s physical symptoms are attributed to their mental illness. When doctors know a patient has depression, for example, they’re less likely to think her headache or abdominal pain portends a serious illness”.

There are many examples listed and further statistics from linked studies to indicate that such biases lead to less-than-ideal treatment (or lack thereof) for mentally ill patients. It points to a problem of separating behavioral health from regular healthcare and the need to better integrate the two fields. An earlier study reported higher rates of chronic medical problems among people with chronic mental illness, and chronic illness is known to increase risk of death. They suggested in their conclusions that “psychiatrists need to be adept at caring for physical illness, and primary-care physicians need to acquire skills in caring for the mentally ill”.

The author, Dr. Dhruv Khullar, sums it up this way:

After decades of fragmenting medicine into specialties and subspecialties, it’s perhaps not surprising that a siloed system often fails those in need of whole-person care. I still sometimes wonder if I had let my patient’s mental illness overshadow his physical needs. Did I overlook some subtle cue?

Our hope here at MedicalMime is that more systematic rehab EHR and practice management systems will help behavioral and mental health facilities converge in their practices and treatment approaches towards more mainstream healthcare systems and best practices. It starts with systematic tracking of patient data, treatment and outcomes, all hallmarks of any modern EHR system.

]]>http://medicalmime.com/how-much-does-mental-illness-reduce-life-expectancy/feed/0Gartner BI bake-off analyzes US Opioid Epidemic Datahttp://medicalmime.com/gartner-bi-bake-off-analyzes-us-opioid-epidemic-data/
http://medicalmime.com/gartner-bi-bake-off-analyzes-us-opioid-epidemic-data/#respondWed, 11 Apr 2018 19:19:10 +0000http://medicalmime.com/?p=2466The Gartner Group recently hosted its 2018 BI bake-off event, aimed at getting Business Intelligence vendors to showcase their products capabilities analyzing data as part of the Data for Good movement, using public data sets that support a social cause. After analyzing traffic fatalities, college costs and homelessness in previous years, the 2018 bake-off was on data about the U.S. opioid epidemic. (See also our previous post on the Drug Overdose Epidemic)

From the bake-off blog post:

There were some consistent findings in all the demos on the descriptive side:

The opioid crisis is getting worse, not better.

New York had the most over dose deaths associated with opioids specifically.

When taking into account population density, West Virginia had the most over dose deaths due to overdoses. It’s hard to say for sure if Opioids are the highest cause as the particular drug is not always captured.

Four panelists provided their respective analysis and dashboards: Microsoft, MicroStrategy, Qlik and Tableau.

Each vendor’s demonstrations were both illustrative of their specific features / capabilities as well as interesting findings on the trends of this epidemic. For example, scatter-plots make it easy to pinpoint outliers, in some cases leading directly to doctors who are now under investigations for prescribing exorbitant amounts of drugs. In many cases, there are both short (5-min) summary videos as well as links to publicly available dashboards to discover underlying data patterns interactively.

(1) Pharmaceutical payments to doctors do not affect prescription rates. We were curious whether the data would show a correlation between pharmaceutical company payments to doctors and their rates of prescription. In fact, we found no such correlation. In other words, there is no evidence that direct payments to doctors result in higher prescription rates.

(2) State GDP and opioid usage are inversely correlated. There seems to be a correlation between state GDP and opioid usage as measured by Medicaid claims. States with lower GDPs tend to have higher opioid usage. This confirms that the opioid epidemic has economic factors.

(3) State college education rates and opioid usage are inversely correlated. There also seems to be a correlation between college education and opioid use as measured by Medicaid claims, but not a similar correlation for high school graduation rates. In other words, states with higher rates of upper education (college or beyond) tend to have lower rates of opioid use, but this doesn’t apply to high school education.

For anyone interested in understanding the opioid epidemic in more detail, having access to its public data as well as various interactive visualizations is valuable. Data for Good, indeed.

End Note: The data used in this bake-off does not align exactly with that published by various sources (CNN, NYT, WaPo) linked to in our previous post. Instead, it appears to be offset by 1 year, that is to say that the data 2015 – 2017 in the bake-off aligns fairly closely with that reported previously as for the years 2014 – 2016.

]]>http://medicalmime.com/gartner-bi-bake-off-analyzes-us-opioid-epidemic-data/feed/0Behavioral Economics and Driving Engagement in Digital Healthhttp://medicalmime.com/behavioral-economics-and-driving-engagement-in-digital-health/
http://medicalmime.com/behavioral-economics-and-driving-engagement-in-digital-health/#respondThu, 15 Mar 2018 22:42:32 +0000http://medicalmime.com/?p=2437At the beginning of last week’s HIMSS18 conference in Las Vegas I attended the symposium on Digital & Personal Connected Health. One of the speakers, David Asch from the Penn Medicine Center for Health Care, reported on innovations in Digital Health driven by behavioral economics. Adoption of and engagement with new technologies in healthcare is often lagging behind other industries. Wearables disappear in drawers and new apps struggle to attract and retain users. The average app loses 77% of users after three days and 90+% within a month.

David Asch is also on the Scientific Advisory Board of VAL Health, a consultancy firm with the goal to apply behavioral economics to improve health and health care. In one of the whitepapers from this site the authors explain their approach:

Unlike conventional behavior change approaches that presume people always act in their best interests, behavioral economics recognizes that people are often irrational, yet in predictable ways. In understanding why we make unwise decisions, behavioral economists design solutions that account for and course correct our decision errors.

The insight that people often behave irrationally, but in predictable ways, was illustrated in Dan Ariely’s popular book “Predictably Irrational“. At the root of this seemingly perplexing behavior lie numerous cognitive biases which distort our perception of the world and hence lead us to act in irrational ways. Some examples are recency bias, hindsight bias, overconfidence bias, or status quo bias. A fascinating visualization can be found on the Cognitive Bias Wikipedia Page:

Back to VAL Health’s whitepaper: They list three main tenets of behavioral economics used to improve health outcomes:

Choice architecture refers to setting up a list of choices in such a way that the above biases tend to lead to good outcomes. For example, people tend to get overwhelmed when provided with too many choices, and most people like going with a default choice. The impact of this on public policy was also discussed in great detail in the book “Nudge: Improving Decisions About Health, Wealth, and Happiness” by Richard Thaler and Cass Sunstein. A simple example would be whether a policy automatically enlists people in organ donor registries with the option to “opt-out” or requires them to specifically “opt-in”: Most people go with the default, so it’s easy to see how the choice architecture of public policy will have a big effect on the outcomes.

Framing refers to how alternatives or choices are presented. We often perceive options differently based on how they are framed, even when their probabilities are exactly the same. This is closely related to the concept of loss aversion, the idea that we experience greater pain in losing than pleasure in gaining a given amount. For example, people respond or engage more to avoid losses than to realize gains:

David Asch mentioned this loss aversion as an example in this interview snippet on HIMSS TV, which also touches on the subject of Financial Incentives: When people are given a reward of say $2 / day for one month for each day they reach an activity goal (say walking 10,000 steps), this has only a small and usually quickly decaying impact. However, when people are given the entire amount upfront ($60 for 30 days) and then lose $2 for each day they don’t reach the activity goal, they engage at a significantly higher level. This difference seems surprising, given that the incentive is exactly the same. However, people dislike losing more than they like gaining.

The whitepaper goes into more detail on how knowledge of these biases and the right framing and incentive instruments have been used to improve engagement levels:

I encourage you to download the whitepaper(s) from the VAL Health website to learn more about the details of this work.

All that said, incentives and especially financial rewards are seen as a short-term stimulus or fix. In order to affect lasting behavioral change one needs to achieve habit formation, i.e. the behavior needs to become an ingrained routine which will persist even in the absence of rewards.

Much has been written about how many repetitions or how many days (60+) one needs to form new habits and how to build habit-forming products (See “Hooked” by Nir Eyal). This also touches on the concept of Gamification, i.e. to make ongoing engagement enjoyable like a game, if not addictive. For example, by awarding badges for frequent use a product can appeal to the desire to collect badges for recognition. Or by displaying streaks of uninterrupted goal achievement a product can appeal to the desire to extend a streak.

In summary, behavioral economics starts with the observation that people often behave irrationally, but in predictable ways. It then studies the reasons for such irrational behavior – the cognitive biases. Such insights can and should be systematically applied to the design of health care products, forms, apps, etc. that exploit our behavioral tendencies to achieve better health outcomes.